From the Guidelines
Benign tremors include essential tremor, physiologic tremor, enhanced physiologic tremor, orthostatic tremor, and task-specific tremors. These types of tremors are considered benign because they do not indicate underlying neurodegenerative diseases. The most common type is essential tremor, which is characterized by a postural or kinetic tremor typically affecting the hands, head, or voice [ 1 ].
- Essential tremor can be treated with beta-blockers, such as propranolol, which has been used for more than 40 years [ 1 ].
- Physiologic tremor is a normal phenomenon present in all individuals, usually not visible to the naked eye, but can be enhanced by factors like caffeine, anxiety, fatigue, or certain medications.
- Enhanced physiologic tremor becomes noticeable when exacerbated by these factors.
- Orthostatic tremor occurs specifically when standing and typically affects the legs and trunk.
- Task-specific tremors only appear during particular activities, such as writing (writer's tremor) or playing musical instruments (musician's tremor). Treatment options vary depending on the type and severity, ranging from lifestyle modifications to medications like beta-blockers (propranolol) or anticonvulsants (primidone), and in severe cases, surgical interventions like deep brain stimulation.
- The choice of treatment should be individualized based on the patient's specific needs and medical comorbidities [ 1 ].
- Beta-blockers, such as metoprolol, may also be effective in treating essential tremor, depending on the case [ 1 ].
From the Research
Types of Benign Tremors
- Enhanced physiologic tremor: This type of tremor is an exaggeration of the normal physiologic tremor that everyone experiences, and can be caused by factors such as anxiety, medication use, caffeine intake, or fatigue 2.
- Essential tremor: This is the most common type of tremor, characterized by postural and kinetic tremor, and can affect the hands, head, and voice 3, 4, 5, 6.
- Psychogenic tremor: This type of tremor has a sudden onset, may spontaneously remit, and can change in characteristics over time 2.
- Cerebellar tremor: This type of tremor is caused by damage to the cerebellum, and can be characterized by a wide-based gait and difficulty with coordination 2.
- Dystonic tremor: This type of tremor is caused by dystonia, a movement disorder characterized by involuntary muscle contractions 2.
Characteristics of Benign Tremors
- Action tremors: These occur with voluntary contraction of a muscle, and can be further subdivided into postural, isometric, and kinetic tremors 2.
- Resting tremors: These occur in a body part that is relaxed and completely supported against gravity, and are often seen in Parkinson's disease 2.
- Frequency: Benign tremors can have a variety of frequencies, ranging from low-frequency tremors such as those seen in Parkinson's disease, to high-frequency tremors such as those seen in essential tremor 2.
Diagnosis and Treatment of Benign Tremors
- Diagnosis: The diagnosis of benign tremors is based on clinical information obtained from the history and physical examination, and may involve categorizing the tremor based on its activation condition, topographic distribution, and frequency 2.
- Treatment: Treatment for benign tremors depends on the type and severity of the tremor, and may include medications such as propranolol and primidone, botulinum toxin injections, and surgical interventions such as deep brain stimulation and magnetic resonance-guided focused ultrasound 3, 4, 5, 6.